The European Journal of Public Health Advance Access originally published online on June 23, 2005
The European Journal of Public Health 2005 15(4):361-367; doi:10.1093/eurpub/cki096
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Health Services Research |
Original approach to the individual characteristics associated with forgone healthcare
A study in underprivileged areas, Paris region, France, 2001–2003
Fabienne Bazin, Isabelle Parizot and Pierre ChauvinCorrespondence: Pierre Chauvin, MD PhD, INSERM U707, Faculté de Médecine Saint Antoine, 27 rue Chaligny, 75571 Paris Cedex 12, France, tel. +33 1 44 73 84 60, fax +33 1 44 73 86 63, Email: chauvin{at}u707.jussieu.fr
Background: The social inequalities in health have endured or even worsened comparatively throughout different social groups since the 1990s. Our objective was to identify the individual characteristics (socio-economic status, living conditions, individuals' social integration, health beliefs, expectations and representation and psychological characteristics) statistically associated with the fact of stating (or not) that healthcare had been forgone because of cost. Methods: In this cross-sectional, multi-centre study we randomly selected a study sample from five underprivileged areas in the Paris region. A multiple logistic regression model was used to calculate the odds ratios (OR) and 95% confidence interval (CI). The validity of the model was assessed by goodness-of-fit tests (Pearson and deviance) and by the study of 100 bootstrap samples. Results: After making adjustments for numerous individual socio-economic and health characteristics, we observed a higher occurrence of reported forgone healthcare among people who have had financial worries during adulthood [ORyes/no=5.47 (1.44–20.75)], a life-course experience of physical, sexual or psychological abuse [ORyes/no=2.86 (1.40–5.84)]; who have experienced childhood difficulties [OR1/never difficulties=5.28 (1.81–15.39), OR2–4/never=7.62 (2.69–21.57), OR>4/never=8.57 (2.39–30.80)]; who have expressed a low degree of sickness orientation [ORlow/high=2.62 (1.33–5.14)], a high worry/concern about health [ORhigh/low=2.71 (1.33–5.50)] and a low self-esteem [ORmedium/high=8.28 (1.44–47.64), ORlow/high=16.44 (2.81–96.24)]. Conclusion: Aside from purely financial hurdles, other factors play a role in the non-use of healthcare services. Health policies mainly promoting equal financial access to healthcare have little chance of abating health inequalities.
Keywords: health behaviour, healthcare access, life change events, logistic models, psychosocial factors